1. National context

The new National Action Plan on Drugs (2011–15), like its predecessor, endorses the visionary goal of a society free from narcotics, while one of its long-term objectives is to reduce the harm caused by the use of alcohol, narcotics, doping and tobacco. The evaluation of the 2006–10 National Action Plan on Drugs further suggested that county councils should broaden the range of evidence-based interventions targeting drug users, including needle and syringe exchange. To support the health promotion and prevention efforts among PWID implemented at the regional level, guidelines on the prevention of infectious diseases are currently being drawn up by the Public Health Agency, highlighting relevant research and knowledge.

The first needle and syringe programme (NSP) in Sweden began operation in 1986. In 2006, the Swedish government passed a law formally allowing the 21 counties (län) to introduce needle and syringe exchange programmes. Regulations concerning these programmes were drawn up by the National Board of Health and Welfare in February 2007 and define the procedures county councils have to follow. These include: a justification of need (e.g. an estimate of the number of potential service users); an assessment of available resources; and a provision plan for complementary and additional care services (e.g. detox, drug treatment and aftercare). The regulations also stipulate the obligation for NSPs to inform clients about injecting risks and to offer additional services, including vaccinations and testing for infectious diseases, and they define further quality management rules for the implementation of such services. Drug users are eligible to participate in a NSP when they offer proof of identity and are 20 years of age or older.

At the end of 2013 there were five NSP in place in Sweden. Approximately 230 000 syringes were given out and about 1 900 clients were served in 2013 in four NSPs; however, one of these NSPs had only been running for nine months and thus the numbers do not represent the full picture of Swedish NSPs’ activities in 2013. A sixth NSP site opened in October 2014.

The NSPs assist drug users with other medical/social support, offer free HIV, HBV and HCV testing and refer them to drug-free treatment within the social services. Pharmacies are not entitled to sell needles/syringes to people without a prescription for medical use, such as for diabetes care, etc.

To improve bystander response to opioid overdose events, a pilot study covering first aid training and the distribution of the opioid antagonist naloxone kits to those who are likely to witness overdoses is planned.

Structured questionnaire 'Prevention and reduction of health-related harm associated with drug use' (SQ23/29), submitted in 2014. For an explanation of terms used, see the definitions of terms. Availability expert rating scale: